Healthcare Provider Details

I. General information

NPI: 1295024040
Provider Name (Legal Business Name): ROSEMARY RYAN, D.D.S., L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2011
Last Update Date: 04/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 DEARFIELD DR
GREENWICH CT
06831-5351
US

IV. Provider business mailing address

4 DEARFIELD DR
GREENWICH CT
06831-5351
US

V. Phone/Fax

Practice location:
  • Phone: 203-869-2044
  • Fax:
Mailing address:
  • Phone: 203-869-2044
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number StateCT

VIII. Authorized Official

Name: DR. ROSEMARY RYAN
Title or Position: OWNER
Credential: D.D.S
Phone: 203-869-2044